The Impact of Iron and Folate Adherence on the Prevalence of Anaemia in Pregnant Nigerian Women

Abstract

Introduction: The impact of adherence to taking prescribed medications for chronic illnesses has been widely studied with a view to understanding its role on disease burden. This has been extrapolated to the physiologic pregnancy state, where women are expected to take haematinics due to their susceptibility to anaemia. The prevalence of anaemia in pregnancy is reportedly high with more burden on developing countries. This has led to the recommendation of iron and folate supplements for women during pregnancy. Methods: We set out to determine the level of adherence (and deterrents) to taking iron and folate supplements as well as the prevalence of anaemia in pregnant women (18-45 years old) attending antenatal care at the Stella Obasanjo Women and Children Hospital (SOWCH) and the Central Hospital in Benin City, Nigeria between July-December, 2019. An association between occurrence of anaemia and adherence level was also assessed. Results: 400 pregnant women participated in this study. The mean age (±SD) of the study population was 30±4 years, mean gestational age (±SD) was 31±5 weeks. Majority of the women (82.0%) were in their third trimester, 17.5% and 0.5% in second and first trimesters respectively. Total adherence scores obtained ranged from 0-8, with 63.5% being non-adherent to taking their iron and folate supplements. Factors that influenced adherence positively were higher income (p=0.00) and being employed (p=0.01). Top three identified reason for non-adherence were forgetfulness to take prescribed supplement (62.5%), feeling too bored to take supplements daily (44.3%) and unavailability of supplements (38.0%). The mean Hb (±SD) was 10.9±1.1g/dl. The prevalence of anaemia in pregnancy was 46.8%, with mild (43.8%) and moderate (3.3%) forms only. Of the non-adherent group, 69.7% were anaemic versus 30.3% of the adherent group. There was an association between the occurence of anaemia and nonadherence to taking supplements (p=0.01). Conclusion: There is a high level of non-adherence to taking iron and folate, prevalence of anaemia, and an association between them. Benefits of adherence to these supplements should be reinforced to women of child bearing age.